Provider Demographics
NPI:1770622854
Name:ISLAND PHYSICAL THERAPY OF RIVERHEAD
Entity type:Organization
Organization Name:ISLAND PHYSICAL THERAPY OF RIVERHEAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT
Authorized Official - Phone:631-208-4443
Mailing Address - Street 1:185 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901
Mailing Address - Country:US
Mailing Address - Phone:631-208-4443
Mailing Address - Fax:631-208-4448
Practice Address - Street 1:185 OLD COUNTRY RD
Practice Address - Street 2:SUITE 4
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901
Practice Address - Country:US
Practice Address - Phone:631-208-4443
Practice Address - Fax:631-208-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q07B0OtherEMPIRE CATHERINE BARRY
801067OtherEMPIRE GOVT J SCALAMANDRE
QL8661OtherEMPIRE JOHN SCALAMANDRE
126269OtherVYTRA VINCENT BARRY
QM5151OtherEMPIRE VINCENT BARRY
801062OtherEMPIRE GOVT C BARRY
818365OtherEMPIRE GOVT V BARRY
Q07B03Medicare ID - Type UnspecifiedCATHERINE BARRY
818365OtherEMPIRE GOVT V BARRY
QM5151OtherEMPIRE VINCENT BARRY
Q07B0OtherEMPIRE CATHERINE BARRY
NYQ0WMR1Medicare PIN